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1996 Volume 32 Issue 1 Pages
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1996 Volume 32 Issue 1 Pages
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1996 Volume 32 Issue 1 Pages
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1996 Volume 32 Issue 1 Pages
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Kiyoshi Onishi, Yu Maruyama, Kiyoshi Watanabe, Keihachirou Hirano, Mun ...
Article type: Article
1996 Volume 32 Issue 1 Pages
1-6
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Recently, anorectal anomalies has been greatly improved on the therapeutic results. One of the important factors is, however, the anal pasty having the favorable evacuating functions. We have attempted to reduce the complications such as the anal stenosis and the prolapse caused by the anastomosis between the perineal skin and the bottom end of rectum. We have performed the two flap anoplasty using the V flap and the perineal flap, and good rsults were obtained. The position of anus was confirmed by EMG preoperatively. The center of the anus was incised as a position of the central of the V flap, and the perineal flap was formed at the lateral anterior side. The vascular pedicle from posterior side was included. The hight of the V flap is same with those of lateral axis of the perineal flap. The vascular pedicle of the perineal flap is the cutaneous branch of the inferior rectal artery. It's supply has sufficient enough for filling the anal canal, whihc can be easily confirmed during the operation. Also, the inferior rectal branch of the pudendal nerve covers the anal canal. Flap has a suficient sensations as neurovascular flap. Eventually, we could obtain the satisfactory results with two flap plasty functionally and morphologically.
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Takashi Tsuchioka, Toshio Fujiwara, Yuusaku Kurosu, Masakatsu Sunagawa
Article type: Article
1996 Volume 32 Issue 1 Pages
7-14
Published: February 20, 1996
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This experiment was designed to evaluate the effect on the liver cytoskelton (microfilament) by cyclic TPN and continuous TPN. The liver of experimental rats was studied by immunohisitochemical staining procedure usuing actin and myosin. Sprague-Dawley male rats, each weighted about 200 grams, were randomly divided into four groups ; 1) the control group (group I ; n=10), 2) continuous TPN group (group II ; n=7), 3) cyclic TPN-a group (group III ; n=7), and 4) cyclic TPN-b group (group IV ; n=4). In group I, rats were fed with rat chow for 7 days. In group II, group III, and group IV, rats received intravenously the 20% glucose, 3.3% amino acids and 0.5% fat solution prescribed in total parenteral nutrition for 7 days. In group II and group III, rats were sacrificed at 3 hours after TPN solution infusion. In group IV, rats were sacrificed at 10 hours after infusion. In group I, actin and myosin were stained around the hepatic cells. In group II, staining for actin and myosin around the hepatic cells were decreased. In group III and group IV, actin and myosin were stained same as group I. These results suggest that administration of continuos TPN may exchang staining for actin and myosin around the hepatic cells. These changs induced by continuous TPN mya be cause to TPN-associated cholestasis. In cyclic TPN group, these changes in hepatic cells were obvious less than in continuous TPN group. It is concluded that cyclic TPN is an efficient method for liver cytoskelton (microfilament) competed with continuous TPN.
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Hiroshi Matsufuji, Peter J Milla, Jotaro Yokoyama
Article type: Article
1996 Volume 32 Issue 1 Pages
15-23
Published: February 20, 1996
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Despite the definitive surgery using ganglionic segment in children with Hirschsprung's disease (HD), approximately 10%〜20% continue to experience vomiting, diarrhoea, abdominal disetension and severe feeding difficulties. These are suggestive of a motility disorder in the histologically innervated bowel of such children. We have performed antroduodenal manometry to investigate the fasting phase III and fed activities on seven patients with HD and age matched controls (C). Two children were with total colon aganglionosis (TCA), one with long segment aganglionosis and four with rectosigmoid aganglionosis (RSA). All of these children but one with RSA have various abdominal symptoms after the surgery. A three port catheter was placed with the most proximal port in the antrum. Data was analyzed visually and using a computerized analytical program to determine amplitude, frequency, duration, cycle length and direction of propagation. Phase III was shorter in TCA (3.0, 3.6 min.) than HD (5.3〜6.3 min.) or C (6.2 min.) and of lower amplitude (TCA (10, 13 mmHg), HD (23〜45 mmHg), C (16 mmHg)). Antroduodenal hypomotility in TCA was suggested. In a case with RSA direction of phase III propagation was variable and postprandieal activitiy pattern was abnormal. Those may be the causes of upper gastrointestinal dysfunction and poor tolerance of feeds in these children. Furthermore it was suggested that motor disorder of HD is not limited to the aganglionic bowel.
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Akihiro Higuchi, Kazuharu Nagao, Yukio Matsuoka, Mikako Ueno, Yuuich K ...
Article type: Article
1996 Volume 32 Issue 1 Pages
24-28
Published: February 20, 1996
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The incidence and the rate of spontaneous closure of inguinal hernias were studied among 696 very low birth weight infants who were admitted to our Neonatal Intensive Care Unit between 1983 and 1990. The inguinal hernias were diagnosed in 47 of the 696 infants (6.8%), with a significant lower incidence in boys (18/379, 4.7%) than in girls (29/317, 9.1%). As for the weight in relation to gestational age, the incidence of the inguinal hernia was significantly higher in 161 SFD (Small for date) infants than in 532 AFD (Appropriate for Date) infants, with an occurrence rate of 17 (10.6%) and 30 (5.6%) respectivery. Twenty-two of 37 children (59.7%) who responded to our inquiry have experienced spontaneous closure of the hernia at sometime between 2 and 9 years after birth and no serious complicatons including incarcerations have been encountered. Thirteen infants underwent herniotomy not ealier than 6 monts after birth. Our data suggest anoearly surgical intervention of the inguinal hernia in very low birth weight infants might be unnecessary.
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Kohei Takada, Toshihiro Muraji, Yasuyuki Higashimoto, Eiji Nishijima, ...
Article type: Article
1996 Volume 32 Issue 1 Pages
29-32
Published: February 20, 1996
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The quality of life in oncologic patients will improve with a port because of absence of exteracorporeal catheter and infrequent visits to the outpatient clinic for flashing when they go back home. An attempt of connection a port to an on-going Broviac catheter in place was made in 10 oncologic patients. This paper summerizes our initial experiences of this technique, its feasibility and safety. The mean functioning time of ports after the connection to Broviac catheter was 460 days (61-1047 days) and the mean functioning time of Broviac catheter in place before the conversion was 229 days (37-600 days) There were no complications related to this attempt. The mean operation time was 43 minutes. The advatages of this new idea are three folds ; 1) No sacrifice of venous route 2) No radiation exposure 3) Short operation time.
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Yasuo Yoshizawa
Article type: Article
1996 Volume 32 Issue 1 Pages
33-42
Published: February 20, 1996
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The aim of this study is to evaluate the efficacy of fine emulsified fat in the enteral nutrition. The study was performed in 8 weeks old rats with obstructive jaundice (J group) and without jaundice (sham operation group ; S group). Rats in every group were fed with isocaloric diet (60kcal/day) consisted of carbohydrate, protein, minerals and vitamins. Fat modules were supplemented as follows. The emulsified soy bean oil (10%, particle sizes : 0.1-0.3 micrometer) was given in J (JE) and S (SE) groups. The commercial soy bean oil (unemulsified) was given in J (JB) and S (SB) groups. These fat modules accounted for 13% of the total calorie in every diet. All nutrients were administered into the stomach via a gastric tube for 28 days. Values of fatty acids in plasma total lipid fraction were determined by gaschromatography. The emulsified fat was as well absorbed in JE group as in SE group. While the unemulsified fat was markedly less absorbed in JB group. A typical pattern of fatty acid deficiecy with reduction in linoleate and arachidonate, and increase in palmitoleate, oleate and 5, 8, 11 eicosatrienoate in total lipid fraction of plasma were observed in JB group. These results showed that the emulsified fat, in contrast with the unemulsified fat, is well absorbed from the intestine in jaundiced rats. I suspect that the fine emulsified fat is effective as a fat module of the enteral nutrition in patients with insufficient bile excretion.
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Tadaharu Okazaki, Toshio Fujiwara, Takashi Tuchioka, Yusaku Kurosu, Na ...
Article type: Article
1996 Volume 32 Issue 1 Pages
43-47
Published: February 20, 1996
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Though the hemophilia is a representative disease of the blood coagulation disorders, it is seldom diagnosed in the neonatal period. We have experienced a case of neonate with hemophilia A, who developed intraperitoneal hemorrhage. The patient, a newborn maie, developed anemia and jaundice from the second day after birth. He had slightly distended abdomen, and bluish-colored skin on the left inguinal region and the scrotum. Chest and abdominal X-ray examination showed fraclure of the left clavicle and centralization of the intestine, which suggested intraperitoneal hemorrhage induced by the birth injury. Laparotomy revealed minor rupture of the liver capsule and bleeding from the major omentum. The hemostatic procedure and abdominal drainage were performed. Because of prolonged bleeding from the operative wound, various coagulation tests were examined. They showed a markedly prolonged PTT and a drop of antihemophilic factor to less than 2%, which established the diagnosis of hemophilia A. We reported the case, and also reviewed the Japanese literatures.
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Takayuki Kuga, Takashi Inoue, Kensuke Esato, Kouichi Ueki
Article type: Article
1996 Volume 32 Issue 1 Pages
48-53
Published: February 20, 1996
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A rare case of poor prognostic Askin tumor is reported. A 13 year-old girl was admitted to our hospital because of left shoulder pain, chest pain and cough. She had a tumor in her left chest wall with pulmonary effusion. CT and MRI revealed a left thoracopulmonary tumor. A biopsy specimen which was obtained under the ultrasonographic guidance revealed Askin tumor. The extirpation of the tumor and chest wall, a partial resection of the left lung and reconstruction of the chest wall were performed after pre-operative chemotherapy. After the operation, chemotherapy and PBSCT were performed. There was neither recurrence nor residual tumor at MRI and scintigraphic studies in the 5th post-operative month. She was discharged 5 months after surgery. She had a recurrence in the 7th post-oprative month, and then underwent a re-operation. We are now planning to perform the post-operative chemotherapy and irradiation. Askin tumor is a rare disease with a poor prognosis. A treatment has not been established yet. The tumor of our case vanished completely with the operation and chemotherapy, but recurred. Our case suggests that patients with Askin tumor should be followed with intesive surveillance.
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Kouji Masumoto, Sachiyo Suita, Tomoaki Taguchi, Takeshi Yamanouchi, Mi ...
Article type: Article
1996 Volume 32 Issue 1 Pages
54-63
Published: February 20, 1996
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Three cases of body stalk anomaly were reported. Case 1 and case 2 were diagnosed antenatally as a body stalk anomaly by ultrasonography. Case 1 was born with a caesarean delivery, and showed a giant omphalocele, a severe scoliosis, and a short umbilical cord. She died of respiratory failure caused by hypoplastic lungs soon after birth. Autopsy revealed ventricular septic defect, hepatic cyst, aplasia of gall baladder and clubbed legs. Case 2 was also born with a caesarean delivery, with a ruptured omphalocele associated with a severe lordoscoliosis and a short umbilical cord. She died of respiratory failure causerd by hypoplastic lungs one hour after birth. Additionally, left diaphragmatic defect was recognized by autopsy. Case 3 was diagnosed antenatally as a omphalocele, and was born with a caesarean delivery. He was associated with severe scoliosis and short umbilical cord. He passed away because of respiratory failure caused by hypoplastic lungs 2.5 hours after birth. The associated anomalies were dextrocardia, symmetric liver, right hydronephrosis, right undescended testis and Spina bifida. We diagnosed his condition as a body stalk anomaly retrospectively. Autopsy of these cases revealed the lung-body weight ratio was very low ; 0.23% in case 1, 0.42% in case 2, and 0.56% in case 3. We highlighted that the poor prognosis of this anomaly was mainly derived from severe hypoplasty of the lung.
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Tomohisa Wada, Michinori Arita, Toshihiko Kohashi, Yoshinori Kuroda, Y ...
Article type: Article
1996 Volume 32 Issue 1 Pages
64-71
Published: February 20, 1996
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A 4-year-old boy was admitted due to intermittent abdominal pain. Barium enema showed twisted ascending colon and Upper GI series showed nonrotation of intestine. At laparotomy, a congenital fibrous band between ascending and transverse colon was found. But the cecal volvulus has been already detorted by barium enema. The fibrous band was resected and appendectomy was performed. The postoperative course was uneventfull and the patient was discharged 2 weeks after surgery. Cecal volvulus in children is very rare. Sixteen cases have been reported in the world. We suspect the cecal volvulus in this patient was directly derived from the assoicated nonrolation of intestine with the abnormal fibrous band.
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Toshihiko Saga, Tohru Shinohara, Hidetaka Oku
Article type: Article
1996 Volume 32 Issue 1 Pages
72-74
Published: February 20, 1996
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Two children underwent surgical treatments of iliofemoral arterial obstruction with prosthetic garafts and the follow-up angiograms demonstrated satiesfactory long-term results without any clinical evidence of ischemia of the diseased extremities. A 15 year-old boy had undergone implantation of oversized bifurcated prosthetic graft between abdominal aorta and both-side iliac arteries at the age of 11. Follow-up angiography, 4 years after the surgery, demonstrated better coaptation at each of the anastomosis as the consequence of adequate growth of aorta and the iliac arteries. A 10-year-old boy had undergone establishment of left-sided ilio-femoral bypass with the optimal-sized prosthetic graft at the age 4. Follow-up angiography, 6 years after surgery, demonstrated patent blood flow through the graft and also progressing mismatch in its size to the contralateral native iliac artery. Prosthetic grafts have been employed in a limited number of pedialric patients with peripheral vascular lesions and, to the best of our knowledge, their long-term results have not ever been reported in Japan. Present study suggests prosthetic graft can be applied with favorable results to the reconstruciton of peripheral vascular lesions in the pediatric patients, if it were the only available procedure of choice.
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Hirofumi Nakamura, Hisao Kemmotsu, Kazuya Joe
Article type: Article
1996 Volume 32 Issue 1 Pages
75-78
Published: February 20, 1996
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Three cases of intestinal strangulatin evaluated with CT are reported. The characteristic CT findings included (a) concentric circular distribution of fluid-filled dilated bowel loops, (b) thickening of the bowel wall, (c) small bubbles dotted along the margin of fluid-filled dilated bowel loops, and (d) edematous mesenteric folds converging toward a point of torsion. In two of the three cases, the necrotic segments of the intestine were resected, and in the rest case, a volvulus of the small intestine around its mesentery was reduced before the intestine was infarcted. The early diagnosis of intestinal strangulation is critical in decreasing in the morbidity and mortality of this potentially life-threatening condition, and it is sometimes difficult to diagnose clinically or with routine plain abdominal films. Because CT is rapid, noninvasive, and specific in the preoperative diagnosis of intestinal strangulation, the emergency CT should be performed in patients whose clinical examination and plain abdominal films are nondiagnostic.
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Kohei Takada, Yasuyuki Higasimoto, Eiji nisijima, Yuka Ogawa, Masayuki ...
Article type: Article
1996 Volume 32 Issue 1 Pages
79-82
Published: February 20, 1996
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A 9-month-old girl, who had undergone closure of colostomy after Swenson's procedure for Hirschsprung's disease, was admitted to our hospital because of severe rectal bleeding. the rectal bleeing, requiring blood tarnsfuaion recurred five days after admission. Colonofiberscopy revealed diffuse follicular lymphoid hyperplasia with severe oozing in the pull-throughed colon. The proximal mucosa appeared normal. The findings of colonofiberscopy suggested that diversion of fecal stream cause colonic lymphoid hyperplasia. Salazosulfapyridine and elemental diet were administrated. There was no furhter bleeding thereafter. Three months later, impaired mucosa turned normal. Diversion colitis is a nonspecific inflammatory change ocuuring in the segment of colorectum alter surgical diversion of the fecal stream by placement of colosotmy or ileostomy. Although severe rectal bleeding due to diversion colitis is uncommon, our exprinece suggested thai diversion colitis may induce serious illness.
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[in Japanese]
Article type: Article
1996 Volume 32 Issue 1 Pages
83-87
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[in Japanese]
Article type: Article
1996 Volume 32 Issue 1 Pages
88-114
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1996 Volume 32 Issue 1 Pages
115-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1996 Volume 32 Issue 1 Pages
115-
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[in Japanese]
Article type: Article
1996 Volume 32 Issue 1 Pages
115-
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[in Japanese], [in Japanese], [in Japanese]
Article type: Article
1996 Volume 32 Issue 1 Pages
115-116
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1996 Volume 32 Issue 1 Pages
116-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1996 Volume 32 Issue 1 Pages
116-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1996 Volume 32 Issue 1 Pages
116-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]
Article type: Article
1996 Volume 32 Issue 1 Pages
116-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1996 Volume 32 Issue 1 Pages
116-117
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1996 Volume 32 Issue 1 Pages
117-
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[in Japanese], [in Japanese], [in Japanese]
Article type: Article
1996 Volume 32 Issue 1 Pages
117-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1996 Volume 32 Issue 1 Pages
117-
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